Welcome to a special international issue of Rehabilitation Nursing. In this edition, we are pleased to have represented authors and their scholarly work from 11 countries including Brazil, Germany, China, the United States, South Korea, Turkey, Iran, Taiwan, Canada, Australia, and Poland. In America, we are blessed to have access to the best rehabilitation services in the world. Rehabilitation nursing is a growing and thriving specialty. This is not the case in many other parts of the globe. To give our readers a unique perspective on where rehabilitation nursing is in the world, I invited my dear friend Chris MacDonell from CARF International, to join me in sharing thoughts about the state of our nursing specialty in the world.
CARF International has been accrediting organizations and programs outside of North America since 1996. One of the great lessons learned was that the field of rehabilitation nursing is alive and well in North America and almost nonexistent in other parts of the world.
The integral part that rehabilitation nursing plays in interdisciplinary rehabilitation may be taken for granted in some organizations. However, when one is exposed to an interdisciplinary model where there is no rehabilitation nursing or it is an intuitive process by some general nurses, it becomes evident that, without this key group, results and the durability of those results become lost. Such is the unfortunate state of many countries that have not been able to see the value of rehabilitation nursing.
The Association of Rehabilitation Nurses has been a member of CARF's International Advisory Council for a number of years and has shared incredible resources and key individuals from their leadership to assist CARF in our work with international providers (http://www.carf.org/Resources/IACResources/).
In countries that are developing their rehabilitation presence, such as China, the need for multiple levels of training and education is critical. One of the articles in this issue discusses the value of educating Chinese nurses about rehabilitation, demonstrating that knowledge does increase with a structured educational program. In China, the basic nursing education is there, but the emphasis is on technical tasks and the role of the nurse to carry out physician orders. Because of extreme shortages and the values embraced in Chinese culture, families play roles that in Western cultures nurses and nursing assistants would be performing. So, when a rehab nurse is not interacting with that family member, many of the critical components of teaching and follow-through with techniques learned in therapy are missing. The role of the nurse in comparison to physicians and therapists is somewhat diminished because the philosophy and therapeutic approach is not part of their core curriculum. Leadership, autonomy, team building, and assertiveness are not generally taught in nurse's basic training in China. Thus, introducing core competencies that we use here in the United States requires a paradigm shift that is not always supported by the Chinese health system. The positive aspect of this challenge is that the nurses working in rehabilitation settings are like sponges for new information. They are eager to learn and have more training in the concepts of rehabilitation nursing. However, finding the resources and expertise to make this happen remains a challenge.
Another difference from North America is evident in areas of the Middle East where the work force is extremely diverse. Workers in rehabilitation come from 40 to 50 different countries. Many nurses are recruited from India and the Philippines. The patient population in Middle Eastern facilities may be homogeneous, but the workforce is diverse. How does that impact consistent, value-based rehabilitation nursing? Think about having staff from 40 different education programs where you are not aware of the curricula, the certifications, or licensing requirements. This lack of clear understanding of the expectations could be problematic when it comes to identifying key competencies that will be necessary. Throw in the need for nurses from another country to be person-centered and culturally sensitive to a different culture that they are not totally aware of and, in some cases, not comfortable with. This mix can make it very difficult to move generalist nurses into the role of rehabilitation nursing experts. However, one of the keys is education, education, education.
ARN has taken a giant step in defining the role of the rehab nurse in the United States and developing a professional competency model to guide practice and research. Although most traditional nursing programs in the United States still do not offer a stand-alone course in rehabilitation, the ARN model provides a concrete framework from which to view this specialty practice. We hope that some rehabilitation nursing content is provided in most schools, yet we are far from our goal of having rehabilitation nursing being integrated into all nursing curricula to become a part of standard nursing practice. The ARN model is also not a perfect fit for the role of the rehabilitation nurse in other countries because the service needs there may be quite different. Yet, as international leaders in rehabilitation, we have to ask ourselves what our responsibility is to share our knowledge with developing countries to improve patient care.
The need for an International Association of Rehabilitation Nursing now seems critical. Just like the International Brain Injury Association (IBIA) and the International Society of Physical and Rehabilitation Medicine (ISPRM), the world becomes smaller through an association and begins to develop and improve the quality and prevalence of rehabilitation nursing occurring in rehab programs. The role of education and research to develop the field of rehabilitation nursing is at a critical cross road. Imagine if those in North America that have a long and rich history moved into the international stage. We would like to see what the combined efforts of organizations like ARN and CARF International could accomplish to get essential rehabilitation nursing education to those that most need it. Moving ahead, we look forward to an international market where rehabilitation nursing is an active and productive member of the interdisciplinary team.
Christine M. MacDonell, FACRM
Managing Director Medical Rehabilitation and
International Aging Services/Medical Rehabilitation
CARF International Tuscon, Arizona, USA
Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, ACHPN, FAAN
Editor-in-Chief
Colorado Christian University
Lakewood, CO